Healthcare Provider Details

I. General information

NPI: 1124490495
Provider Name (Legal Business Name): MATTHEW GREGORY MILLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL DORADO ST
MONTEREY CA
93940-4606
US

IV. Provider business mailing address

333 EL DORADO ST
MONTEREY CA
93940-4606
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4877
  • Fax: 831-372-0485
Mailing address:
  • Phone: 831-375-4877
  • Fax: 831-372-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number45591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: